Omental wrap: Radiographic diagnosis confirmed surgically – Report of two cases in Grenada

Omental wrapping is a common cause of peritoneal catheter malfunction. This diagnosis should be confirmed by radiography before proceeding with surgical omentectomy. We report two cases of peritoneal dialysis (PD) catheter outflow obstruction from our developing PD program in Grenada, in which contrast studies accurately diagnosed omental wrap, allowing for prompt surgical correction. In both cases, the contrast study indicated the presence of omental wrapping, confirmed at time of surgical correction. Radiographic features of omental wrap are distinctive, which allows for reliable differentiation from other causes of obstruction. Radiographic contrast study reliably diagnoses the cause of peritoneal catheter obstruction, permitting prompt diagnosis and treatment. This is vital for regions with limited access to haemodialysis.

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P1147SEQUENTIAL ULTRASOUND BASED APPROACH IN PERITONEAL CATHETER MALFUNCTION: THE COMBINATION OF B-MODE AND DOPPLER ULTRASOUND

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1147 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Matthias Zeiler ◽

Antonio Federico ◽

PAOLO LENTINI ◽

Roberto Dell'Aquila ◽

Antonio Granata ◽

...

Keyword(s):

Guide Wire ◽

Abdominal Cavity ◽

Adult Patients ◽

Clinical Approach ◽

Peritoneal Catheter ◽

Omental Wrapping ◽

Doppler Us ◽

Functional Aspects ◽

Dialysis Solution ◽

Catheter Malfunction

Abstract Background and Aims The clinical approach to peritoneal catheter malfunction consists usually in laxative prescription, abdominal radiography, brushing of the catheter lumen, guide-wire manipulation or catheter fluoroscopy. Only specialized centers apply videolaparoscopy for catheter rescue interventions. Up to now, limited experience is present regarding the evaluation of the intraperitoneal tract of the peritoneal catheter in adult patients. The aim of the study was to evaluate the diagnostic capability of B-mode ultrasound (US) followed by colour Doppler US (Doppler US) in persistent peritoneal catheter malfunction. Method US followed by Doppler US of the intraperitoneal part of the catheter was performed prior to videolaparoscopy intervention in 40 adult patients presenting persistent peritoneal catheter malfunction despite non-invasive therapy such as laxative prescription and brushing of the catheter lumen. US and Doppler US diagnosis were compared to the corresponding at videolaparoscopy intervention, and the causes of mismatch analyzed. In all patients US was performed after filling of the abdominal cavity with peritoneal dialysis solution of at least one liter. Doppler US along the intraperitoneal segment of the catheter was performed by flushing with dialysis fluid. Results In US, causes of persistent malfunction were catheter dislocation combined with omental wrapping in 21 cases, omental wrapping without dislocation in 11 cases, dislocation only in 4 cases, adherences to non-omental structures in 3 cases and entrapment in the lateral inguinal fossa in one case. The correspondence of US and videolaparoscopy diagnosis was 90%, respectively in 36 of 40 cases. The discrepancies were due to improper visualization of the catheter caused by constipation and embedding of the catheter between intestinal loops, resulting in an erroneous US diagnosis of omental wrapping, whereas videolaparoscopy showed encasement of the catheter between intestinal loops in three cases and presence of adherences to tubal structures in one case. Doppler US clarified the functional aspects of the catheter, thus increasing the correspondence to videolaparoscopy up to 39 out of 40 cases (97.5%) Conclusion US combined with Doppler US is helpful in making a correct pre-operative diagnosis of persistent peritoneal catheter malfunction and in planning of the videolaparoscopy rescue intervention.

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Diagnostic capability of ultrasound in peritoneal catheter malfunction compared to videolaparoscopy

Peritoneal Dialysis International ◽

10.1177/0896860821993946 ◽

2021 ◽

pp. 089686082199394

Author(s):

Matthias Zeiler ◽

Antonio Federico ◽

Paolo Lentini ◽

Roberto Dell’Aquila ◽

Stefano Santarelli ◽

...

Keyword(s):

Guide Wire ◽

Diagnostic Value ◽

Kappa Coefficient ◽

Peritoneal Catheter ◽

Omental Wrapping ◽

Prospective Multicentre Study ◽

Catheter Malfunction ◽

The Us ◽

Diagnostic Capability ◽

Therapeutic Sequence

Background: The approach to peritoneal catheter malfunction consists usually in a diagnostic and therapeutic sequence of laxative prescription, abdominal radiography, brushing of the catheter, guide-wire manipulation or fluoroscopy and in the end of a videolaparoscopy (VLS) rescue intervention. Ultrasound (US) is able to find out major causes of peritoneal catheter malfunction, however without a clearly defined diagnostic value. The aim of the study was to validate the diagnostic capability of US in catheter malfunction compared to the diagnostic reference of VLS. Methods: US scans of the subcutaneous and intraperitoneal segment of the catheter were performed prior to a VLS intervention in 40 adult patients presenting persistent catheter malfunction within a prospective multicentre study. Laxative prescription and brushing of the catheter lumen were undertaken prior to US scan. US diagnosis was compared to the corresponding at VLS, kappa coefficient calculated and the causes of mismatch analysed. Results: In US, causes of persistent malfunction were catheter dislocation combined with omental wrapping in 21 cases, omental wrapping without dislocation in 11 cases, dislocation only in 4 cases, adherences to non-omental structures in 3 cases and entrapment in the lateral inguinal fossa in 1 case. The US diagnosis corresponded to the respective at VLS in 36 of 40 cases, resulting in a kappa coefficient of 0.89 (95% CI: 0.78–1.00). The discrepancies were due to improper visualization of the catheter between omentum and intestinal loops, resulting in an erroneous US diagnosis of omental wrapping. Conclusions: This study suggests that US might have a pivotal role in the diagnostic approach to peritoneal catheter dysfunction.

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Laparoscopic treatment strategies for peritoneal catheter malfunction by ovarian fimbriae

Saudi Journal of Laparoscopy ◽

10.4103/2542-4629.193037 ◽

2016 ◽

Vol 1 (1) ◽

pp. 3

Author(s):

Zeiler Matthias ◽

Santarelli Stefano

Keyword(s):

Treatment Strategies ◽

Laparoscopic Treatment ◽

Peritoneal Catheter ◽

Catheter Malfunction

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The Value of Peritoneoscintigraphy in the Investigation of Ultrafiltration Loss during Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089301302s17 ◽

1993 ◽

Vol 13 (2_suppl) ◽

pp. 70-74

Author(s):

Bozena Pietrzak ◽

Elzbieta Panasiuk ◽

Janusz Przedlacki ◽

Zofia Wankowicz

Keyword(s):

Peritoneal Dialysis ◽

Normal Control ◽

Peritoneal Catheter ◽

Peritoneal Equilibration Test ◽

Catheter Malfunction ◽

And Function

Perltoneoscintlgraphy (PSG) was performed In 18 patients with ultrafiltration (UF) loss during peritoneal dialysis (PD). In 9 patients PSG was abnormal after peritonitis (PT), and transfer to hemodialysis (HD) was necessary. In three cases peritoneal catheter malfunction was suspected, and PSG provided Information about the catheter's position and function. In two cases loss of UF was connected with extraperitonealleakage of the dialy818 solution (which was confirmed by PSG). In cases of UF 10.. and normal control, the peritoneal equilibration test (PET) was used, and Its result was abnormal for glucose D/Do (too high). PSG was useful for diagnosing the reasons for UF loss during PD.

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Implantable insulin pumps: diagnosis and management of decreased flow rates using radionuclide investigation

The International Journal of Artificial Organs ◽

10.1177/039139889601901208 ◽

1996 ◽

Vol 19 (12) ◽

pp. 723-729

Author(s):

H. Boulahdour ◽

A. Behar ◽

M.-J. Haardt ◽

J-L. Selam

Keyword(s):

Insulin Pumps ◽

Distal Catheter ◽

Non Invasive ◽

Step Procedure ◽

Catheter Obstruction ◽

Catheter Malfunction ◽

Invasive Method ◽

One Step ◽

Isotonic Sodium Chloride

The aim of this study was to develop a diagnostic procedure for pumping unit malfunction by radionuclide imaging (RI) and to validate the method by comparing the results with those obtained using more conventional methods. Fifteen radionuclide investigations were performed in 11 patients with intraperitoneal implantable insulin pumps. One mCi of 99 mTc in 1 ml isotonic sodium chloride was injected into the reservoir. The results based on catheter visualization and peritoneal accumulation were compared blindly to the efficacy of alkaline rinses and laparoscopic findings. In all RI stoppage cases except one alkaline rinses failed to restore flow. Where laparoscopy was performed, comparisons were concordant i.e. no outflow from the tip of the catheter. The RI images obtained were reproduced in vitro using a pump under normal flow conditions and complete proximal and distal catheter obstruction. RI is a safe, quick non invasive method which allows the location of the site of pump/catheter malfunction within a one step procedure and the prediction of the efficacy of sodium hydroxide rinses.

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Peritoneal catheter fixation combined with straight upward tunnel and low implant position to prevent catheter malfunction

Nephrology ◽

10.1111/nep.12968 ◽

2018 ◽

Vol 23 (3) ◽

pp. 247-252 ◽

Cited By ~ 3

Author(s):

Qingyan Zhang ◽

Chunming Jiang ◽

Wei Zhu ◽

Cheng Sun ◽

Yangyang Xia ◽

...

Keyword(s):

Peritoneal Catheter ◽

Implant Position ◽

Catheter Malfunction

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Ultrasound in the diagnosis of peritoneal catheter obstruction in children

Kidney International ◽

10.1038/ki.2012.132 ◽

2012 ◽

Vol 82 (4) ◽

pp. 499 ◽

Cited By ~ 4

Author(s):

Francesco Esposito ◽

Marco Di Serafino ◽

Paolo Sgambati ◽

Paola Erra ◽

Carmela Mercogliano ◽

...

Keyword(s):

Peritoneal Catheter ◽

Catheter Obstruction

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Practice of Peritoneal Dialysis Catheter Flushing in Australia and New Zealand: Multi-Center Cross-Sectional Survey

Peritoneal Dialysis International ◽

10.3747/pdi.2017.00108 ◽

2017 ◽

Vol 38 (2) ◽

pp. 98-103 ◽

Cited By ~ 2

Author(s):

Yeoungjee Cho ◽

Neil Boudville ◽

Suetonia C. Palmer ◽

Josephine S.F. Chow ◽

Carmel M. Hawley ◽

...

Keyword(s):

Peritoneal Dialysis ◽

New Zealand ◽

Clinical Care ◽

Peritoneal Dialysis Catheter ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Effective Interventions ◽

Catheter Obstruction ◽

Catheter Malfunction ◽

On Line

Background Evidence of effective interventions to prevent peritoneal dialysis (PD) catheter malfunction before first use is presently insufficient to guide clinical care. Regular flushing of the PD catheter (e.g. before PD commencement) has been adopted by some practitioners in the belief that it will prevent catheter obstruction and/or malfunction. The aim of this study was to characterize and evaluate PD catheter flushing practices across Australian and New Zealand PD units. Methods An on-line survey was distributed to all 62 PD units in Australia (12 August 2016; n = 51) and New Zealand (2 February 2017; n = 11), with questions relating to PD catheter flushing practices, audit, and outcomes. Results Forty-nine units of variable size (< 16 to > 100 patients) completed the survey (79% response rate). All centers flushed PD catheters at some stage after insertion as routine unit practice. Forty-one units (84%) routinely flushed during periods of PD rest at varying intervals ranging from alternate daily to monthly. The type and volume of solution used to flush varied between units. Units that practised routine flushing of PD catheters were almost twice as likely to audit their catheter-related outcomes (66% vs 38%, p = 0.23) and more likely to have reported blocked catheters in the preceding 12 months (84% vs 0%, p = 0.01) compared with those units that did not routinely flush PD catheters. Thirty units (61%) regularly audited and monitored catheter-related outcomes. Conclusions This study identified a wide variation in center practices relating to PD catheter flushing. Drawing conclusions about any relationship between flushing practices and clinical outcomes was impeded by the relatively low uptake of regular auditing and monitoring of catheter-related outcomes across surveyed units. Evaluation of the benefits and harms of standardized PD catheter flushing practices on patient outcomes in a randomized trial is needed to guide practice.

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